NURSING 2P03 Study Guide - Winter 2018, Comprehensive Midterm Notes - Diabetes Mellitus, Stroke, Hypertension
12 Oct 2018
School
Department
Course
Professor
NURSING 2P03
MIDTERM EXAM
STUDY GUIDE
Fall 2018
Shock Clinical Reasoning and Decision Making Lab
Shock
• Inadequate tissue perfusion.
• Hypovolemia, neurogenic trauma, anaphylaxis, sepsis, and cardiac pump dysfunction.
Pathophysiology
• Imbalance of oxygen supply and demand leads to decreased tissue perfusion and
impaired cellular metabolism.
• Causes lactic acid and waste products to build up in the cells causing cellular injury,
inflammation and death.
• Known as systemic inflammatory response syndrome (SIRS).
• Triggered y ody’s iue respose to ifetio.
o Kupffer cells re-harvest the heme of the red blood cells.
o Kupffer cells become inflamed and die, the heme is unable to be reabsorb and
put back into circulation, decreasing O2 delivery.
o Most metabolic processes such as growth occurs with presence of O2.
o Not enough ATP is produced to carry out cellular processes.
• Cellular death occurs as by-products kill neighboring cells.
• With significant cell death, significant over production of clotting factors occurs.
o Small clots interrupt blood flow to the organs.
• Disseminated intravascular coagulation causing multi-organ failure and death.
Understanding Shock
Hypovolemic Shock
• Occurs from loss of blood, plasma, or fluid.
• Trauma patients, burn patients, alcoholic patients, and those with severe diarrhea and
vomiting.
• Critical decrease in intravascular circulating volume.
o Preload is diminished, decreased cardiac output.
• SIRS begins, progresses to shock and death.
• Treatment
o Rapid blood/fluid replacement with treatment to stop the cause of fluid loss.
o Vasopressive agents.
o Cardiac monitoring, vital signs, and monitoring intake and output.
o Supplemental oxygen.
o High risk for falls.
Distributive Shock: Anaphylactic, Neurogenic, Septic
• Changes in blood vessel tone (mimics hypovolemic shock).
• Circulatory volume stays the same, systemic vascular resistance is decreased.
find more resources at oneclass.com
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• Vessels a’t deliver the irulatig volue to the orgas.
• O2 delivery is impaired, beginning cycle of cellular inflammation.
• Vessels need more volume to fill the void and systemic vascular resistance needs to be
increased.
Anaphylactic Shock
• Acute allergic reaction to be stings, drugs, foods.
• Have headache, light-headedness, flushed, itch, anxious.
• Treatment
o Establish and maintain airway, may require bronchodilators or epinephrine with
wheezing.
o Nebulizer treatments.
o Intravenous fluid bolus with crystalloids.
o Epinephrine to increase systemic vascular resistance.
o Histamine blockers and steroids.
Neurogenic Shock
• Traumatic injury to spinal cord.
• Vehicle accidents, falls, sports injuries, tumors, infections, vertebral fractures.
• Sympathetic nervous system is interrupted.
• Cateholaie’s are ot released, tahyardia and diaphoresis is inhibited.
• Patients will have slow weak pulses, hypotension, and hypothermia.
• Rapid respiratory rate to compensate for increased O2 demand.
• Vasodilation below level of the injury, pink warm and dry.
• Proximal to injury, skin is cool, clammy, and pale.
• Treatment
o Maintain airway, supplemental O2.
o 2 large bore intravenous lines for rapid fluid administration.
o Vasopressors.
o Kept warm to prevent shivering.
o Use steroids to decrease inflammation around spinal cord, or surgical
intervention to relieve
Septic Shock
• Infection process.
• Release of cytokines and other inflammatory processes.
• SIRS triggers clotting cascade.
• Risk in elderly, those with diabetes, immunocompromised (HIV, oncology, splenectomy).
• When immune system is overwhelmed, trouble generating fever or white blood cells.
• Hypothermic with normal or low white blood cell counts.
• Treatment
o Supporting breathing and ventilation with supplemental O2.
o 2 different intravenous sites.
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Inadequate tissue perfusion: hypovolemia, neurogenic trauma, anaphylaxis, sepsis, and cardiac pump dysfunction. Anaphylactic shock: acute allergic reaction to be stings, drugs, foods, have headache, light-headedness, flushed, itch, anxious, treatment, establish and maintain airway, may require bronchodilators or epinephrine with wheezing, nebulizer treatments. Intravenous fluid bolus with crystalloids: epinephrine to increase systemic vascular resistance, histamine blockers and steroids. Intubation to increase o2 consumption rate: central venous lines imperative to monitor central venous pressure, vasopressors used with hypotension, human activated protein c, inhibits thrombosis and inflammation and regulate coagulation to decrease sirs. Identify underlying cause: maintain airway, administer vasopressors, vasodilators, diuretics, and analgesics to improve cardiac output and decrease o2 demand, surgical intervention may be required. qsofa. Identify patients with suspects infection who are at risk for poor outcome outside of. Icu: 3 criteria, low bp (sbp less than 100mmhg), high respiratory rate (greater than 22 breaths per minute), altered mentation (glasgow coma scale less than 15), score ranges for 0-3 points.
